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[Rufus657]

Hi.

I’ve had to stop taking HRT due to ongoing issues with bleeding and it’s too much hassle despite the amazing benefits I experienced. I also took testosterone gel which also was a great help with libido. 

Can I continue to take the testosterone gel in small amount if I have quit HRT. Thanks for you help on this. 🙏

[Hurdity]

Hi Rufus

Taking testosterone gel on its own in the absence of systemic HRT is not generally recommended due to potentially becoming T dominant and adverse adrogenic effects.

See this statement by the Bitish Menopause Society:

https://thebms.org.uk/2023/03/bms-statement-on-testosterone/

"Although studies have shown that testosterone can be beneficial in
women not using concomitant estrogen containing hormone therapy, the incidence of adverse
androgenic effects such as acne and excess hair growth is higher; this strategy is therefore not usually
recommended in routine clinical practice."

In that statement there is a link to the more detailed guidelines on T replacement in menopause (Tools for Clinicians).

It may be possible in consultation with a specialist who will monitor your T levels - but likely only privately which will be costly.

Hurdity x

[joziel]

It's probably worth trying to find a solution for the bleeding. A Mirena coil often works excellently where other things have been tried and haven't helped....

[bombsh3ll]

I second the suggestion of a mirena IUS.

If this is unsuitable then there are multiple oral progestins that can be tried. They tend to be a lot more effective against bleeding than micronised progesterone if that's all you've tried.

If you have concluded that estrogen based HRT isn't for you though, then yes testosterone can be used by itself.

Some of it will convert into estradiol anyway.

It isn't the routine standard of care and some providers may not be comfortable but absolutely it is an option and there are no safety concerns with taking it alone provided you are appropriately monitored for blood levels and side effects.

Another alternative you could consider is tibolone which provides estrogen, androgen and endometrial protection all in one bleed free oral option.

[Hurdity]

If you have concluded that estrogen based HRT isn't for you though, then yes testosterone can be used by itself.

Some of it will convert into estradiol anyway.

This is often quoted - the conversion of T to oestrogen at inadequate levels of oestrogen, but I have never seen any evidence from trials that this actually happens. If you know of any, then please post!

Yes it is on the steroid metabolic pathway as one of the precursors and is converted to estradiol by the enzyme aromatase, but that's not to say it will actually be converted because of enzyme controls, feedback mechanisms and tissue specific manufacture, so I understand (though my understanding is hazy!)?

The only information I've found on this was the product monograph for the Intrinsa patch discontinued a number of years ago which showed no change in estradiol levels after administration of the T patch after a year, in one of the trials though participants were also receiving estradiol replacement transdermally and orally.

Hurdity x